Assessments for cause of hypercoagulable state is recommended. Blood pressure measurements, tick borne disease panel are also recommended. Full coagulation panel is warranted. The concern is that the splenic thrombus will extend further into the portal vein and cause potential prehepatic portal hypertension. Plavix therapy would be warranted as well as internal medicine management. Potential splenectomy and removal of the splenic vein may be necessary in this patient. However, underlying causes should be investigated such as infectious disease, occult neoplasia or other causes of hyper coagulable state, such as Cushings.